8 risk adjustment coder jobs found

Incentives Physician Office | Kettering | Full-Time | First Shift Overview Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God's love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care. Responsibilities & Requirements This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. KPN Pro Fee Coding Specialist Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Reviewing the...

Kettering Health Network is seeking a full-time Risk Adjustment Coder for their office in Kettering, OH. This role focuses on coding compliance and ensures adherence to CMS billing rules while supporting clinical outcomes through documentation feedback to providers. The ideal candidate will have a High School Diploma, relevant coding certifications, and prior experience in professional fee coding. This position fosters relationships with healthcare providers and contributes to improving coding practices. #J-18808-Ljbffr

Job Details Physician Office | Kettering | Full-Time | First Shift Responsibilities & Requirements Job Overview: The Certified Risk Adjustment Coder is responsible for reviewing the ambulatory records for the appropriate risk adjustment components. The Risk Adjustment Coder will identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes. The Risk Adjustment Coder will leverage the MEAT (Monitor, Evaluate, Assess, Treat) criteria for accurate documentation by providers. When appropriate, the Risk Adjustment Coder will query providers to clarify the HCC codes placed, inquire on additional documentation to support the HCC code placed, or discuss overall opportunities within the record. The Risk Adjustment Coder will supplement the educational offerings of the MSO by providing right-time feedback to providers when documenting or coding the risk adjustment on patient records. The Risk Adjustment Coder...

A healthcare organization in Kettering, Ohio, is seeking a Certified Risk Adjustment Coder. This full-time role involves reviewing ambulatory records and coding outpatient patient records to ensure accurate risk adjustment. Candidates must hold an Associate or Bachelor’s degree in Health Information Management and have at least one year of coding experience. Certification as a Certified Risk Adjustment Coder (CRC) is required. Strong communication skills and teamwork abilities are essential for successful collaboration with providers and clinical documentation specialists. #J-18808-Ljbffr

KPN Pro Fee Coding Specialist This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Reviewing the ambulatory records for the appropriate risk adjustment components Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy] Demonstrate initiative for maintaining current knowledge of...

Job Details Physician Office | Kettering | Full-Time | First Shift Responsibilities & Requirements Responsibilities & Requirements This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. KPN Pro Fee Coding Specialist Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Reviewing the ambulatory records for the appropriate risk adjustment components Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee...

Job Summary Designs and delivers education programs on compliant documentation, coding and billing practices, regulatory requirements, and internal policies through learning experiences such as instructor-led sessions, webinars, and e-learning modules. Serves as a key resource for physicians, clinical staff, auditors, coders, and other stakeholders, ensuring understanding and adherence to applicable standards. Analyzes data and reports to identify educational needs and may conduct limited audits to support targeted training efforts. Essential Functions: Develops and delivers targeted education based on new service or program implementation, CPT/ICD-10 changes, and regulatory changes. Reviews audit data and compliance trends to identify educational gaps and address areas of risk. Designs and maintains educational content and resources, supporting accurate CPT and diagnosis coding for professional services,...

ABOUT LLCHCLower Lights Christian Health Center (LLCHC) transforms the overall health of Central Ohio, serving one individual at a time. We are focused on whole-person wellness, available to ALL in Central Ohio who need it, regardless of ability to pay! In 2019 alone, we served over 12,000 patients - with 40% being uninsured - and totaled 50,000+ medical encounters!Operating out of seven locations, we offer medical care (primary care, dental, vision, OB/GYN, telehealth), behavioral health care, 340B pharmacy, nutritional assistance programs, and more. Working hours are Monday - Friday with occasional Saturday morning coverage.SUMMARY:The Medical Billing Specialist ensures accurate coding, timely claim submission, and efficient reimbursement for clinical services. This role reviews documentation, assigns codes, prepares and submits claims, follows up on denials, and maintains compliance with payer policies and HIPAA.ESSENTIAL JOB RESPONSIBILITIES:Review clinical documentation and...